Healthcare Provider Details

I. General information

NPI: 1912397431
Provider Name (Legal Business Name): ETHAN DAVID CATRON LMSW CAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date: 03/21/2022
Reactivation Date: 05/20/2022

III. Provider practice location address

500 CASCADE WEST PKWY SE STE 240
GRAND RAPIDS MI
49546-2166
US

IV. Provider business mailing address

4250 BUTTRICK AVE SE
ADA MI
49301-9223
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-9000
  • Fax: 616-591-9060
Mailing address:
  • Phone: 269-449-4298
  • Fax: 630-690-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801108107
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: